The revelation that girls as young as 14 can have an abortion without their parents’ knowledge has come as a shock to many. Don’t schools have to tell parents if they know a girl is pregnant? Don’t the parents have any right to know what is going on? What if something went wrong with the abortion procedure? A whole host of questions have been asked in the wake of the Michelle Smith case, but those who work with young people know just how essential it is that confidentiality is maintained.

Since 1986, doctors and other health workers have been working according to the Fraser guidelines, formulated after the case in which Victoria Gillick unsuccessfully challenged the legality of girls under 16 getting contraceptive advice without their parents’ knowledge. Under these guidelines confidential advice and treatment can be given to young people provided certain conditions are met.

Part of the recent confusion has stemmed from a lack of knowledge about the situations in which workers can give confidential advice to young people. While schools will have their own confidentiality policies, these do not cover health professionals working on their premises. Teachers may not be able to guarantee confidentiality to a pupil, but health professionals must, just as they would if they worked in a hospital or doctor’s surgery. And this is essential if young people are to be encouraged to seek help.

"Young people need access to confidential advice. They have made it clear that they won’t seek advice if they think someone is going to talk to someone else," says Anne Weyman, chief executive of the Family Planning Association.

She says that young people often delay talking to anybody for fear that professionals will tell their parents. But with pregnancy, whatever the girl decides, early support is vital.

There will be extraordinary circumstances where a health worker will break confidentiality. This may happen if they consider that the young person is incapable of making a decision for themselves, or where the young person or another child is in danger.

Nonetheless, while health workers will not threaten to tell others, they will encourage young people to speak to their parents, provided it is in their best interests. But for some young women, telling their parents will be the worst thing they can do.

"There are families where if they discovered their daughter was having sex they might attack or kill her because of the shame on the family," says Phillip Hodson, speaking on behalf of the counselling in education division of the British Association for Counselling and Psychotherapy, which includes teachers and nurses with counselling training.

Even in less extreme cases, there may be good reasons why a girl would prefer not to tell her parents. It might be that she does not get on with them, or she may worry that her parents will pressurise her into a course of action against her wishes.

However, consulting the right professionals can help a young person to reach the right decision.

"Instead of seeing a worker who is mainly concerned to find a solution they need to see a professional counsellor who is concerned to give and bring insight into the situation. It takes five years to train as a counsellor," says Hodson.

In order for young people to know what help is available, services need to be brought to their attention. And it’s down to those services, NHS or otherwise, to not only advertise their wares but to make it clear that confidentiality will be respected.

"Traditionally you don’t get advertisements for GUM (genito-urinary medicine) clinics but young people need to know where there are places they can go to get help. There’s no point them saying ‘There’s a sexual health clinic around the corner but I still won’t go because they might tell someone’," says Anna Martinez, co-ordinator of the Sex Education Forum.

One way to make seeking sexual health services more attractive is to make them available at school.

"If you look at the evidence, you find that there are lower teenage pregnancy rates and better sexual health in general in countries where sex education is linked to health services, such as where schools have health services on site or where a health visitor visits a class," says Martinez. And making sure services are welcoming to young people, and are open around school hours can make all the difference.

What seems clear is that any moves to weaken the rules around confidentiality would lead to more children and young people suffering alone.